Episode 400: 408. CME Obesity and MASH

• GLP1 drugs work but they likely need lifestyle modifications

• No convincing evidence GLP1 cause thyroid cancer in humans BUT contraindication if family history exist

• Stopping therapy usually results in weight gain

• Insurance coverage for weight loss is limited and variable

• Semaglutide for type 2 diabetes max dose is 2.0 mg weekly Semaglutide for weight loss has a goal dose of 2.4 mg weekly
• Diagnose steatotic liver disease with imaging and 1 metabolic risk factor (or biopsy)

• After diagnosis check FIB-4:
  • Low risk, continue to monitor with FIB-4 every 2-3yrs
  • Intermediate risk, order VCTE and consider referral if >F1
  • High risk order a VCTE and referral (20% end with SLD)

• 2 FDA approved medications for liver fibrosis are not cheap, expect insurance push back